The Public's Health

In a box in my basement — amongst a broken TI-83 calculator, Discman, and other college-era artifacts — is a poster entitled “Forever 27.” Once ubiquitous in dorm rooms, the poster depicts Jimi Hendrix, Janice Joplin, Jim Morrison, and Kurt Cobain in a Daliesque purgatory at the age when all of them died after bouts with substance abuse: 27 years old. In addition to being a tribute to rock legends, the poster embodies the popular belief that fame and fortune lead to excess consumption, which occasionally leads to an early, but glamorous, demise.

While there is probably some truth to this logic, a study published last month in the open-access medical journal BMJ Open suggests that something far earlier in their lives — exposures to extreme stress during critical periods of childhood development — may be behind a substantial portion of rock stars’ premature mortality.

These kinds of stressorsare known to trauma researchers as ACEs. The name comes from the Adverse Childhood Experiences (ACE) Study, a large research project started in the 1990s that discovered a strong, graded relationship between childhood trauma and stress and the leading causes of adult death in the United States. The research spawned many other studies, and we have written about several on this blog. The original research designated each type of trauma or stressor — growing up with an alcoholic parent, for example, or being physically abused or neglected — as an ACE. Among the ACE study’s findings, adults who'd experienced one ACE as children were twice as likely to have become addicted to illicit drugs at some point in their lives than people who'd experienced zero ACEs. Those with three ACEs were over three times as likely; a person with five or more ACEs was nearly eight times as likely to have become addicted. A similar relationship was identified between ACEs and alcohol abuse.

The recently published research on early deaths among rock stars is part of a larger study of 1,489 pop stars who achieved fame between 1956 and 2006 (Elvis Presley to Amy Winehouse). The authors investigated 137 cases of musician mortality in that group. Using biographic information from a variety of sources, they determined each star’s ACE score — it's based on a standard set of 10 questions — and whether their death was “substance abuse or risk related.”

Musicians who died from substance abuse-related causes were nearly twice as likely to have ACEs than those who died from other causes. Forty-seven percent of stars who died substance abuse-related deaths had one or more ACEs compared to only 25% of those who died from other causes. The likelihood of dying from substance abuse-related causes also increased with each additional ACE. Fully 80% percent of the stars with two or more ACEs died from substance abuse-related causes compared to 41% of those with one ACE and 31% of those with zero ACEs.

Why might rock and pop stars’ childhood experiences be related to their cause of death? It’s possible that the association observed is the result an information bias in the study. More comprehensive biographical information, and thus more opportunity to identify ACEs, might be available about stars who died high-profile, substance abuse-related deaths — giving the impression that these stars had more ACEs, when they really only had more ACEs that the researchers knew about. What’s more likely, however, is that ACEs predisposed some stars to engage in risky behaviors — and fame and fortune then gave them the opportunity to pursue them.

Rock stars are a small but highly influential group. Their lives, and deaths, shape the public’s thinking about cause and effect, risk and resilience. The popular narrative of rock star premature mortality —fame leads to fortune leads to excess leads to death — doesn’t account for other factors that may lead some of these rock stars to live life in the fast lane. When it comes to the lifelong consequences of childhood adversity, the latest study suggests that rock stars are pretty much like everybody else.